Therapy Constipation

"Okay, I'm here. We've talked about my history, my family and the symptoms I'm experiencing. But I'm stuck. I don't know what to talk about next. What should I say?"

If you've ever spent time in therapy you can probably relate. In one session things are moving along fine - you're discovering things about yourself, flashbulbs of insight are going off all around you and the conversation between you and the therapist is rolling at a comfortable pace. There are so many thoughts and ideas coming to mind you wish you would have booked a double.

And in the next session, you draw a blank.

You're not sure where to start. None of the topics you covered before seem very interesting, and nothing new comes to mind. You start to worry that you're wasting your time and money. You ask yourself if maybe therapy isn't working, or if you've done all you can and maybe it's time to stop. You even worry about disappointing your therapist; that he or she will start to see you as a difficult client. While these thoughts race through your head, you're aware of the ticking clock and the awkward silence in the room. Part of you wants the session to end mercifully soon, while another part wants to figure this out and get back to the good work you were doing last week.

Ever been there? I don't know if I'm the first person to use the phrase "therapy constipation," but that's what I'm calling this phenomenon. The emotional, relational, intellectual information is in there, it just won't come out. Those of us sitting in the other chair might call it "resistance" or a "defense", but that could be an overstatement. You may just need the emotional equivalent of a bran muffin to get the system moving again. Here are some tips I've found helpful for occasional therapeutic irregularity:

Talk about it: Rather than trying to push away the "stuck" feeling and trudge through other material, try talking about it with your therapist. All those thoughts and feelings mentioned above are worthwhile therapeutic topics. Furthermore, since you are experiencing them at this very moment, you could gain some insight into why you feel blocked. Does this stuck feeling happen in other settings? Could it be that "stuckness" serves some function in your life, protecting or sabotaging you somehow? Is there a problem between you and the therapist that needs to be addressed? Why feel stuck today? All worthwhile material for a session.

Take the whole hour: Many clients show up right at their appointment time; straight from work, traffic, and trying to find parking and are understandably unprepared to dive into their psyche. It's hard to downshift into therapy mode when you're in a rush. Instead of the typical 50 minute therapy session, plan to show up 10 minutes early to sit with yourself, relax and collect your thoughts. I'll take it a step further and suggest you don't dive into the magazines in the waiting room. That's right, I'm saying don't get lost in the very magazines we leave for you. Try sitting without distraction for a few minutes - what you need to discuss in session may come to you.

Journal: A common statement I hear from clients: "Oh! I had something I wanted to talk about today but I can't remember what it was." Pick up one of those cool journals from the bookstore, carry it with you and jot down important thoughts, ideas or questions that come to you during the week. It doesn't need to be a long, drawn out "Dear Diary" entry each day - just a few words or sentences will do. It's particularly useful to journal after your session to help record the insights you just learned before they evaporate in your busy life. Another bonus comes after you've been in therapy for a while and re-read some of those early entries to see your progress.

"What do I want?" and "How do I feel?": Most therapy sessions boil down to these two essential questions. They can serve as a "home base" for you during sessions. If you reach a moment where you feel stuck and don't know what to say, you can always come back to these questions. You can even say them aloud - it will help the therapist know what you're thinking about.

Sit with it: My Zen-friendly readers and fellow bloggers might know what I'm talking about. So you find yourself temporarily stuck, not sure what to talk about. Rather than push to fill the space with words, how about you just sit in silence for a little while? Silence in therapy is not uncommon and is nothing to fear - if you and your therapist can handle just being quiet, you may find yourself relaxing and eventually the words will come. Some people have such a strong need to perform and achieve that doing nothing for a few minutes may be the hardest (and most enriching) work they do in therapy.

The bail out: Occasionally, Jane will want me to bail her out: "I don't know what to talk about today - could you just ask me questions for a while?" This isn't a bad thing, Jane recognizes her dilemma and is asking for help. Sometimes I'll oblige. But my chances of asking precisely the right question to address what Jane needs to talk about today are slim. We could fill the time with me asking Jane about the issues I think are important, but then the session becomes less about her ideas and more about mine. On her drive home she'll be thinking, "Well, that was interesting, but what I really needed to talk about was ______". I encourage clients to take the time to assess their own needs before resorting to the bail out.

I guess you could say the first five are bran muffins and the bail out is a harsh laxative. It's helpful in times of great discomfort, but use it with restraint.

Dr. Howes,
I appreciate your talking about "therapy constipation" in your blog. Not many take the time to talk about th subject but, if someone sticks with therapy long enough it's bound to happen. I have found that "talking about it" and "sitting with it" have both been strategies that serve me well. Thanks for the other ideas too.

There are days where I jot down notes for myself on papers and stick them in my purse only to forget they are there, when in session, my purse on my lap - papers forgotten. But there are days where I've said what I want and then, i say, "That's all I got. Don't know what else to tell ya". Most of the time because I'm exhausted and turning yourself inside out is hard work. Revisiting your stresses to go over with your therapist and then getting upset again. Then they talk you down and you're calm and... there's 30 minutes left.

I'm guilty of the bail out mainly on days where I feel so scattered, I know the person sitting in front of me is not. He helps bring me back. Usually, he doesn't probe with questions, but instead, recaps what I was on about the week before and asks about progress, usually leading me into something meaningful that I can take with me. That way I don't leave feeling like I've wasted my time. I consider that very important teaching and to sleep during class is just not going to fly...

I very much enjoy reading your blog, it has great points and reminds us to keep the person in front of us in perspective, not the idea of the therapist.

Yes, this has happened to me, but it has never been a problem. If we have worked on a particularily hard problem and it took 40 minutes instead of 60 I'll say, "That has given me a lot to work on. But now I am emotionally drained. How are you?" At other times I have felt like I just can't find the words to express my feelings. It's easy to tell him that. I like him a lot and I respect him. I trust him to be able to guide us back to the work at hand and help me with the next step. Usually he sumerizes what we just talked about. Sometimes he suggests that if we are finished with that topic, he'd like to go back to something we were discussing last week. And do you know what? Sometimes it is okay to ask, "Are you looking forward to your vacation?" and just talk about everyday normal things - a garden, a pet, a holiday.... Not often, but sometimes. He can usually come up with a good joke if we're at an end. Sometimes I say "I feel like we've done enough for today. I think I will leave early and give you a little break." But he would not let me leave if he felt I was holding something back. He would approach from a different angle. He is very good at his job so constipation isn't a problem.